warfarin and Pain

Hemorrhage is the most prevalent adverse effect of oral anticoagulant therapy. The incidence of bleeding complications is related to the duration and range of therapy. A patient on long-term warfarin anticoagulation developed a spontaneous intracapsular bleed into a total hip arthroplasty that had been implanted 11 years before. Joint aspiration allowed early recognition with immediate resolution of symptoms. Diagnosis and treatment of this rare complication are discussed with a review of the literature.

Topics: Aged; Aged, 80 and over; Anticoagulants; Hemorrhage; Hip Prosthesis; Humans; Joint Diseases; Male; Pain; Prevalence; Time Factors; Warfarin

This reports an arm edema that was initially treated as cellulitis and later diagnosed to be subclavian thrombosis due to pacemaker wire irritation. We present an 87-year-old Caucasian man with 5 weeks duration of left arm swelling and pain that was treated with two courses of antibiotics. An axillary venous Doppler study was interpreted as normal with no evidence of venous thrombosis. However, a venogram showed evidence of thrombosis involving the left innominate, subclavian, and axillary veins with multiple collateral veins diverting the blood to the contralateral side and into the superior vena cava. Intravenous anticoagulation was initiated and subsequently the patient was maintained on warfarin (Coumadin). The thrombosis subsequently improved and the original pacemaker was maintained. Arm edema are commonly mistaken for cellulitis, causing a delay in a more definite diagnosis of subclavian thrombosis. In a setting of a patient with pacemaker, subclavian thrombosis should be considered even with a normal screening venous ultrasound test. The incidence, manifestation, venous Doppler, and venogram findings are reviewed and discussed. Upper arm edema and superior vena cava syndrome are the most common presentation of this subclavian thrombosis associated with pacemakers. Venous ultrasound tests may be normal and a venogram is usually required to establish a diagnosis.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arm; Axillary Vein; Brachiocephalic Veins; Cellulitis; Collateral Circulation; Diagnosis, Differential; Edema; Humans; Incidence; Injections, Intravenous; Male; Pacemaker, Artificial; Pain; Radiography; Subclavian Vein; Superior Vena Cava Syndrome; Thrombosis; Ultrasonography, Doppler; Vena Cava, Superior; Warfarin

Subcutaneous (SC) low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) are safe and efficacious for bridging anticoagulation after warfarin interruption. Although LMWH and UFH are self-administered by >90% of patients, factors that may be important to patients such as differences in pain and ecchymosis have not been explored.. We randomized 24 patients to receive SC LMWH or SC UFH twice-daily during the perioperative period. Injection associated pain was recorded using a visual analogue scale and area of ecchymosis was measured by digital photography of the injection site on the day of the procedure.. The area of ecchymosis was 2-fold higher with UFH than LMWH (19.4 cm(2) vs. 8.98 cm(2); P = 0.33) and pain was similar with both treatments (115 mm vs. 171 mm; P = 0.25), though neither finding attained statistical significance.. This exploratory study was underpowered to detect differences between the groups. Further studies are needed to reliably compare pain and ecchymosis in LMWH vs. UFH.

Topics: Anticoagulants; Ecchymosis; Heparin; Heparin, Low-Molecular-Weight; Humans; Pain; Preoperative Care; Warfarin

Patients who are receiving warfarin therapy require frequent blood testing to monitor the intensity of anticoagulation. Although previous studies suggest that capillary blood monitoring of the international normalize ratio (INR) is rapid and reliable, patient preferences for the method of blood drawing have not been investigated.. We performed a randomized controlled trial of patients attending an anticoagulation clinic in which patients were randomly allocated to undergo capillary or venous INR monitoring. Patient satisfaction with the outpatient visit, pain associated with blood drawing, and time spent in the clinic were assessed for each patient.. Sixty patients were studied. Using a 10-point visual analogue scale to quantify patient satisfaction (0-very satisfied; 10-very dissatisfied), patients expressed a strong preference for capillary INR monitoring over venous INR monitoring (1.64 vs. 4.45; P < 0.001). Using a 10-point visual analogue scale to quantify pain with blood sampling (0-no pain; 10-very painful), patients who underwent capillary INR testing had less pain than venous INR testing (0.83 vs. 2.23; P < or = 0.004). Patients spent, on average, 33 fewer minutes in the clinic with capillary INR testing than venous INR testing (P < 0.001).. Our findings support the routine use of capillary blood testing, using a portable monitor, for the management of patients in outpatient anticoagulation clinics.

Topics: Ambulatory Care Facilities; Anticoagulants; Blood Specimen Collection; Capillaries; Catheters, Indwelling; Causality; Comorbidity; Female; Humans; International Normalized Ratio; Male; Middle Aged; Ontario; Pain; Patient Satisfaction; Thrombosis; Veins; Warfarin

To determine the safety of joint or soft tissue aspirations and injections in patients taking warfarin sodium.. The outcome of 32 joint or soft tissue aspirations or injections in patients receiving stable doses of warfarin sodium was assessed through a standardized interview 4 weeks after the procedure. The primary outcome measure was significant joint or soft tissue hemorrhage, ascertained by patient-reported increases in swelling or warmth at the procedure site.. None of 32 procedures was complicated by joint or soft tissue hemorrhage reported by the patients, yielding, by the "rule of threes," a risk of significant hemorrhage of < 10% (with 95% certainty). Diagnostic information was obtained for 53% of aspirated sites (8 of 15) and therapeutic benefit was noted in 74% of corticosteroid-injected sites (17 of 23).. Joint or soft tissue injections and aspirations in selected patients taking warfarin sodium are associated with a low risk of hemorrhage and are often of diagnostic or therapeutic value.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthritis; Bursitis; Connective Tissue; Evaluation Studies as Topic; Female; Hemarthrosis; Hemorrhage; Humans; Injections; International Normalized Ratio; Joints; Male; Middle Aged; Needles; Pain; Prospective Studies; Self-Assessment; Suction; Warfarin

Topics: Aged; Anticoagulants; Female; Humans; Iliac Vein; Pain; Pelvis; Phlebography; Treatment Outcome; Varicose Veins; Warfarin

Topics: Catheterization, Central Venous; Central Venous Catheters; Humans; Male; Pain; Venous Thrombosis; Warfarin

Thromboangiitis obliterans (TAO) is a chronic, non-atherosclerotic, progressive inflammatory vascular disease affecting the small- and medium-size arteries and veins of the extremities.. To evaluate whether long-term anticoagulation with low-molecular-weight heparin (LMWH) and warfarin is beneficial for treating the inflammation and symptoms associated with TAO.. Patients with TAO who underwent anticoagulation as the mainstay of treatment were included in this prospective study. Rest pain relief and healing of trophic lesions (as the primary and secondary endpoint) were investigated at Day 14 and after 6 months of follow-up. High sensitivity C-reactive protein (hsCRP), monocyte count, and ankle-brachial index (ABI) were recorded, and the difference was compared before and after 2-week anticoagulation. The Chi-square test was used to compare the difference between anticoagulant and aspirin groups (based on the literature).. From 2014 to 2019, 18 patients were included. Only 1 patient with wet gangrene received endo-therapy for a failing stent at the start of treatment. After ~14 days, 12 of 13 (92%) patients showed complete ulcer healing, and 17 of 18 (94%) patients showed complete relief from rest pain. Monocyte-counts and hsCRP levels decreased significantly (p<0.001) after a 2-week period of anticoagulation with LMWH. The mean follow-up was 2.6 years (range 0.5-5 years). At 6 months, all patients showed relief of rest pain and complete healing of trophic lesions. All endpoints were significantly improved compared with the aspirin group (p<0.01), and no rest pain or ulcer/gangrene recurred during follow-up.. Anticoagulant therapy may alleviate the inflammation and symptoms of TAO.

Topics: Anticoagulants; Aspirin; C-Reactive Protein; Gangrene; Heparin, Low-Molecular-Weight; Humans; Inflammation; Pain; Prospective Studies; Thromboangiitis Obliterans; Treatment Outcome; Ulcer; Warfarin

Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented.

Topics: Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Blue Toe Syndrome; Computed Tomography Angiography; Diagnosis, Differential; Enoxaparin; Foot; Humans; Male; Pain; Tibial Arteries; Toes; Warfarin; Young Adult

Topics: Anticoagulants; Atrial Fibrillation; Echocardiography, Doppler; Embolectomy; Humans; Lower Extremity; Male; Mitral Valve Stenosis; Pain; Rheumatic Diseases; Treatment Outcome; Venous Thromboembolism; Warfarin

Topics: Adult; Female; Hemoglobin C Disease; Homozygote; Humans; Pain; Warfarin

Spontaneous retroperitoneal hematoma (SRH) can be fatal, requiring immediate recognition and intervention. Current literature is limited, providing little direction in patient care.. To describe clinical characteristics of patients with SRH during an 8-year period.. Observational cohort study of all consecutive patients 18 years and older with SRH from January 2000 to December 2007. SRH was defined as unrelated to invasive procedures, surgery, trauma, or abdominal aortic aneurysm.. Of 346 patients screened, 89 were eligible. Median age was 72 years; 56.2% were male. Overall, 66.3% were anticoagulated: 41.6% on warfarin, 30.3% heparin, and 11.2% low-molecular-weight heparin; 30.3% were on antiplatelet therapy; 16.5% were taking both anticoagulant and antiplatelet medications; 15.3% were taking neither. Primary presentation to the Emergency Department was seen in 36%; 64% developed SRH during inpatient anticoagulation therapy. The most common symptom was pain: abdominal (67.5%), leg (23.8%), hip (22.5%), and back (21.3%); 10.1% were misdiagnosed upon their initial encounter. Computed tomography (CT) was performed in 98.8%, ultrasound in 22.1%, and magnetic resonance imaging in 3.5%. Of all subjects, 40.4% were managed in an intensive care unit; 24.7% underwent interventional radiology (IR) procedures and 6.7% surgical evacuation; 75.3% received blood transfusion. Mortality was 5.6% within 7 days, 10.1% within 30 days, and 19.1% within 6 months.. SRH is uncommon but potentially lethal, with a non-specific presentation that can lead to misdiagnosis. One-third of the cohort was not taking anticoagulants. CT was effective at identification. Most patients received aggressive management with transfusion or IR procedures.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Transfusion; Chi-Square Distribution; Critical Care; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Partial Thromboplastin Time; Platelet Aggregation Inhibitors; Radiology, Interventional; Retroperitoneal Space; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Anticoagulants; Dose-Response Relationship, Drug; Eye Diseases; Female; Humans; Hyphema; Pain; Treatment Outcome; Warfarin

Phlegmasia dolens is a rare form of massive venous thrombosis of the lower extremities that is associated with a high degree of morbidity, including venous gangrene, compartment type syndrome, and arterial compromise. We report the sonographic findings in a patient who presented with phlegmasia dolens.

Topics: Aged; Anticoagulants; Femoral Vein; Heparin; Humans; Leg; Magnetic Resonance Angiography; Male; Pain; Phlebography; Rare Diseases; Saphenous Vein; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Warfarin

Topics: Adult; Anticoagulants; Cumulative Trauma Disorders; Edema; Exercise; Heparin, Low-Molecular-Weight; Humans; Male; Pain; Phlebography; Subclavian Vein; Upper Extremity; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Antihypertensive Agents; Cilostazol; Drug Therapy, Combination; Femoral Artery; Fibrinolytic Agents; Humans; Hypertension; Intermittent Claudication; Leg; Male; Pain; Physical Exertion; Ramipril; Tetrazoles; Treatment Outcome; Warfarin

Warfarin is frequently used as an anticoagulant. The most common and serious complication is bleeding. We present a 43-year-old warfarinized patient who was admitted with unilateral groin pain and a neurological deficit of the lumbar nerve root L1-4. A CT scan showed a haematoma in and behind the ilio-psoas muscle extending to below the inguinal ligament, due to a warfarin induced coagulation deficit (INR 7.0) which was reversed on admission with vitamin K. There is no conclusive evidence in the literature supporting either conservative or surgical treatment modalities. Our patient was successfully treated conservatively.

Topics: Acute Disease; Adult; Anticoagulants; Femoral Nerve; Hematoma; Humans; Inguinal Canal; Lumbar Vertebrae; Male; Nerve Compression Syndromes; Pain; Pain Management; Peripheral Nervous System Diseases; Psoas Muscles; Radiography; Ultrasonography; Warfarin

Topics: Anticoagulants; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Pain; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

Topics: Accidental Falls; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Female; Hematoma; Hip; Humans; International Normalized Ratio; Male; Middle Aged; Pain; Psoas Muscles; Risk Factors; Time Factors; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Danazol is a synthetic androgenic steroid used clinically for the treatment of a wide variety of disorders. Although there is no extensive evidence that androgens are thrombogenic in humans, there are case reports of cerebral, coronary, and peripheral arterial thrombosis in young male athletes abusing anabolic-androgenic steroids. There are also two reported cases of arterial and venous thrombotic events attributed to danazol therapy. We report two additional cases of limb-threatening arterial thrombosis in patients undergoing danazol therapy, and suggest the possibility that danazol may be an independent risk factor for arterial thrombosis.

Topics: Acute Disease; Adult; Aged; Angiography; Anticoagulants; Arteries; Danazol; Drug Therapy, Combination; Endometriosis; Estrogen Antagonists; Female; Heparin; Humans; Leg; Pain; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Anticoagulants; Buttocks; Drug Eruptions; Emergencies; Female; Humans; Middle Aged; Necrosis; Pain; Skin; Venous Thrombosis; Warfarin

Spontaneous hyphaema in patients on systemic anticoagulants has been described in normal eyes and also in eyes with certain intraocular lenses following cataract surgery. These cases are rare and in all the reported cases the hyphaemas resolved without sequelae. Four cases are reported here of spontaneous hyphaemas in previously abnormal eyes of patients on anticoagulants. Three of these patients suffered considerable pain as a result of this. The reasons for this are discussed and early ophthalmic referral recommended if a hyphaema is suspected in these situations.

Topics: Adult; Aged; Eye; Eye Diseases; Female; Humans; Hyphema; Male; Middle Aged; Pain; Warfarin

Pulmonary embolism remains a frequent and often fatal disorder. For the majority of patients, anticoagulation with heparin followed by warfarin represents the primary mode of treatment. Thrombolytic therapy is recommended for the patient with massive pulmonary embolism that has produced hypotension. Embolectomy is reserved for the patient with post embolic systemic hypotension who has an absolute contraindication to thrombolysis or who deteriorates despite thrombolytic therapy. Following successful embolectomy the surgeon must treat the complications of the surgery and prevent recurrence. Complications include cerebral infarction, pulmonary infarction and endobronchial hemorrhage, right ventricular failure, local or systemic bleeding and venous stasis. A case of successful pulmonary embolectomy with a complicated postoperative course is presented and the pathophysiology and treatment of the complications are discussed.

Topics: Adrenal Gland Diseases; Chest Pain; Dyspnea; Female; Heparin; Humans; Hypotension; Middle Aged; Pain; Postoperative Complications; Pulmonary Embolism; Syncope; Warfarin

Forty-seven patients presenting with acute chest pain had in vivo platelet activity assessed by measuring plasma levels of the platelet-specific protein beta thromboglobulin (BTG), and by screening for the presence of circulating platelet aggregates. Nineteen patients with transmural myocardial infarction (MI), 21 patients with acute coronary ischaemia (CI), and 7 patients with non-cardiac chest pain (NCCP) were investigated in a serial study and compared with a normal control group. The means of all BTG determinations in the MI (34, +/- SD = 21-57) and CI (33, +/- SD = 19-57) groups were significantly higher than those in the NCCP group (24, +/- SD equal 17-34; p less than 0.01) and normal subjects (22,5 +/- SD = 14-37; p less than 0.001). There was no difference in BTG between those with MI or CI, nor between the NCCP group and normal subjects. Raised numbers of circulating platelet aggregates could not be detected in either MI or CI. The mean BTG levels in both MI and CI patients were significantly raised, compared to normal subjects, on the first day of admission to hospital and remained so on each of the subsequent nine days. Neither heparin plus warfarin nor sulphinpyrazone had any significant effect in lowering BTG levels. 15/40 patients (37.5%) following MI and CI had repeatedly raised BTG levels throughout the study period, and it is suggested that these patients represent an "at risk" group that may benefit from anti-platelet therapy in secondary prevention studies.

Topics: Acute Disease; Adolescent; Adult; Aged; Beta-Globulins; beta-Thromboglobulin; Blood Coagulation Disorders; Blood Platelets; Coronary Disease; Heparin; Humans; Middle Aged; Myocardial Infarction; Pain; Sulfinpyrazone; Thorax; Warfarin

Six patients developed spontaneous retroperitoneal bleeding while on maintenance dialysis (3% of all patients so treated). At the time of the bleeding episode, four patients were receiving Coumadin for prevention of recurrent clotting problems in external shunts. In three patients, including two who had not received Coumadin, bleeding developed while on dialysis. The presenting common symptoms and signs of retroperitoneal bleeding included sudden and progressive abdominal pain with blood pressure drop and subsequent development of an abdominal mass. These symptoms were associated with a falling hematocrit without any documented external blood loss and with suggestive X-ray changes, including absence of psoas shadow with soft tissue density. All six patients recovered. Treatment included blood transfusions, temporary regional heparinization, withdrawal of Coumadin, and bed rest. Surgical exploration was undertaken in two patients, but no obvious bleeding source was found. Anticoagulation therapy and functional platelet abnormalities may be contributory causes.

Topics: Abdomen; Adult; Female; Hemodialysis, Home; Hemorrhage; Humans; Male; Middle Aged; Pain; Retroperitoneal Space; Warfarin

Clinical features have been correlated with renal function, histology and selective renal angiography in 19 patients with recurrent painless haematuria, recurrent loin pain, or both haematuria and loin pain in whom urinary infection, calculi and anatomical abnormalities of the urinary tract had been excluded. No deterioration in renal function was observed in any patient over periods of up to nine years. Although all patients showed similar glomerular changes histologically, consisting of focal and segmental mesangial thickening and proliferation and periglomerular fibrosis, mild tubular damage was more common in those with loin pain. All patients with loin pain whether or not they had haematuria, had abnormal renal angiograms consisting of focal or generalized vascular lesions sometimes associated with cortical infarcts. The possible aetiological factors are discussed with particular reference to oestrogen-containing compounds.

Topics: Adolescent; Adult; Biopsy; Blood Vessels; Estrogens; Female; Hematuria; Humans; Infarction; Kidney; Kidney Cortex; Kidney Diseases; Male; Pain; Radiography; Recurrence; Renal Artery; Warfarin

Topics: Female; Hemorrhage; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Pain; Retroperitoneal Space; Warfarin

Topics: Aged; Animals; Cattle; Diabetic Angiopathies; Female; Femoral Artery; Humans; Intermittent Claudication; Knee; Leg Ulcer; Male; Middle Aged; Pain; Popliteal Artery; Postoperative Complications; Radiography; Rest; Thrombosis; Transplantation, Heterologous; Warfarin

Topics: Angiography; Catheterization; Dyspnea; Hemoptysis; Heparin; Humans; Leg; Pain; Phlebography; Pulmonary Artery; Pulmonary Embolism; Radionuclide Imaging; Serum Albumin, Radio-Iodinated; Syncope; Technetium; Warfarin

Topics: Abdomen, Acute; Aorta, Abdominal; Aortic Aneurysm; Humans; Male; Middle Aged; Pain; Phlebography; Pulse; Rupture; Vena Cava, Inferior; Warfarin

Topics: Analgesics; Angina Pectoris; Anticoagulants; Drug Synergism; Ecchymosis; Female; Humans; Middle Aged; Oxyphenbutazone; Pain; Warfarin

Topics: Femoral Nerve; Humans; Hypoprothrombinemias; Male; Middle Aged; Pain; Peripheral Nervous System Diseases; Warfarin